Friday, July 30, 2010

Caregiving and Youth

By R. Scott Benson, M.D.

I met a remarkable young woman last week. Sarah (not her real name) was only 15 years old so she couldn’t get a summer job, so she offered to help with her grandmother who had recently returned home from a brief hospital stay. Sarah was pretty excited about the opportunity since she always felt that she was her grandmother’s favorite.

After a few weeks Sarah had what she described as a pretty typical panic attack. Her parents weren’t particularly surprised since Sarah had had some problems with anxiety when she started middle school. Those problems resolved with brief therapy. They quickly arranged for a reevaluation aware that she was at risk for a recurrence of her anxiety problems.

Before she came for the visit she had experienced a couple more panics and was having trouble settling for sleep at night. She couldn’t identify any new stressors. She was positive about her family and peer relationships. She told me her time with her grandmother was going well and she enjoyed the responsibility. She did tell me that her grandmother needed someone with her and the family didn’t have any other easy options.

We reviewed the tools she learned in the sixth grade for control of her anxiety symptoms. Her schedule was a little cramped and she had dropped her regular exercise (she is a runner). We got that going again, talked about her sleep and agreed on a follow-up appointment.

That week Sarah continued having panic attacks and some crying spells. I asked her to tell me a little more about the time she spent with her grandmother. At first she was hesitant since she didn’t want to complain – “Sometimes it’s hard, but it’s okay.” I pressed for more, and she began to cry. It was turning out to be harder than she thought it would be. Her grandmother had gotten mean and complaintful. Nothing Sarah did was right.

She could tell her grandmother was getting forgetful, but she wasn’t prepared for the repeated accusations that it was Sarah who was misplacing, even hiding things from her. Sarah, ever dutiful, would retrace her steps, offer reassurances to her grandmother, only to hear the same accusing questions a few minutes later. The worst for Sarah was her grandmother’s angry name calling, accusing Sarah of stealing, questioning her behavior with her boyfriend, claiming sexual behaviors that never happened.

Sarah had kept all this to herself even questioning if some of these hurtful accusations could be true, thinking her parents would disbelieve that her grandmother would say such things, worried what would happen to her grandmother if Sarah didn’t “tough it out” and help the family keep her grandmother in the family home.

Sarah was relieved to get these problems out in the open. She agreed that we should share these problems with her mother. Her mother was concerned that Sarah was having such a struggle with the grandmother; she knew there were some memory problems but had not seen these behaviors. Both were relieved to hear that these were not unusual behaviors in elderly persons with early dementia.

Sarah’s mother agreed to talk with their family physician about an evaluation for her mother. I talked with Sarah and her mother a little about strategies they could use to help Sarah with some of the stress of this caretaking responsibility. I suggested they look at the information available through the Alzheimer’s Association and the AARP site on caregiving.

Families will be challenged by increased demands for caregiving as the baby boom generation ages. A lot of this caretaking will fall on mature children and adolescents. Currently, there are estimated to be 1 to 1.3 million teens who have caretaking responsibilities. A lot is written about the demands on adults put in a caregiving role realizing that they are subject to depression, anxiety, and burnout. Teens in caregiving roles face the same risks and we need to be prepared to provide the support they need. Some communities have recognized this problem and started programs to provide these young people with the support they need. One program, the American Association of Caregiving Youth in Boca Raton, FL, is bringing national attention.

There is also information about Alzheimer's and the mental health of seniors at

Tuesday, July 27, 2010

Energy Drinks and Our Children

By Gariane Phillips Gunter, M.D.

I was giving a talk to a group of fifth graders regarding mental health issues when one young man raised his hand to ask a question. His question caught me a little off guard as he asked me about using energy drinks. 

Out of curiosity, I asked the group of 100 students to raise their hand if they drank these drinks. To my amazement, most hands went up!!! I then asked them where they got the drinks and they responded that their parents bought them for them. These children opened my eyes to a real problem.

Many children and teens today are choosing energy drinks as a part of their daily diet. And while some energy drinks are clearly labeled as unsuitable for children, others are specifically marketed to kids as young as four, promising boosts in energy and nutrition as well as enhanced athletic performance.

The problem is that this energy boost comes with a price. Most energy drinks, although packaged in smaller cans and bottles than regular soft drinks, are packed with sugar and caffeine — sometimes as much caffeine as in 1 to 3 cups of coffee! Too much sugar can put your child in the fast lane to the dentist's office and also contribute to weight gain. Excessive caffeine comes with its own set of problems — especially in younger kids, it can negatively affect attention and concentration as well as restful sleep.

As adults, we know how it feels to have too much caffeine and our children are no exception. Caffeine by design is a stimulant — though a widely used and accepted one — and because children are smaller than adults and haven't yet developed a tolerance to it, its effects on them may be more pronounced. As in adults, too much caffeine can cause:

• jitteriness and nervousness 
• upset stomach 
• headaches
• difficulty concentrating 
• difficulty sleeping 
• frequent urination

Many of these drinks also contain additional ingredients whose safety or effectiveness has never been tested in children — including herbal supplements, guarana (a source of caffeine), and taurine (an amino acid thought to enhance performance). Children and teens may ingest these drinks without realizing the potential danger. Even mild caffeine toxicity can cause nausea, vomiting hypertension, accelerated heart rate and tremors. Because the Food and Drug Administration does not regulate these drinks it is not possible to know the exact quantities, ingredients or effects they may cause. 

Despite all the hype, energy drinks offer no real health benefits or competitive edge for kids. A balanced diet, physical activity and adequate sleep will work to give our children all the energy they need, safely.

Monday, July 19, 2010

Getting Help: How to Start the Conversation and Find Professional Services

By Felicia Wong, M.D.

Many people don’t seek mental health care when they need it. This is particularly true for members of ethnic minorities, for whom physical illness is often considered more culturally acceptable than mental illness. Research has shown, for example, that Asian Americans are three times less likely than members of other ethnic groups to seek mental health services. This has more to do with lack of appropriate services, and barriers to services—including stigma, language and cultural differences—rather than the lack of need for services.
The important thing to remember is that with proper treatment, most symptoms of mental illness can be controlled. If the possibility of mental illness is a concern for you or someone you care about, please recognize there is no shame in seeking treatment and/or help.

Over the years, many people have asked me how to get help for themselves, a family member or a friend who is suffering. Navigating the mental health system is not easy, and the stigma and shame associated with mental illness make it even more difficult. Where someone may find it easy to ask a friend to recommend a family doctor or a dentist, people sometimes hesitate to ask about psychiatrists or therapists due to fears of being judged, or perhaps appearing "emotionally weak".

There are many places to go for help. A good place to start is by asking your family doctor or primary care doctor. In a crisis, emergency rooms can provide temporary relief for you or a loved one, and emergency room personnel may be able to guide you to further help.

Other potential resources include:
  • mental health specialists such as psychiatrists, psychologists, social workers or mental health counselors;
  • community mental health centers;
  • hospital psychiatry departments, outpatient clinics and/or inpatient units;
  • family services, social agencies, or clergy;
  • peer support groups;
  • private clinics and facilities;
  • employee assistance program; or
  • the phone book or web - search "mental health," "health," "social services," "hotlines," or "physicians" for phone numbers and addresses.

For more information on how to find and choose a psychiatrist and what to expect in treatment, read about Choosing a Psychiatrist on,

Wednesday, July 14, 2010

Cyberbullying: How do you Protect Children from Online Bullies?

By Roberto Blanco, M.D.

f"> With the proliferation of cellular phones and social networking sites, bullying as we once knew it has been changed forever. Gone are the days where the classic nickname pasted on the back or intimidation on the playground were the main forms of peer-to-peer humiliation. Cellular phones with texting and Internet capabilities have allowed adolescents to bully and intimidate their peers at all hours of the day and night. In fact, this type of bullying can begin as early as elementary school.

The meaning and value of friendships and relationships has also been changed. If adolescence wasn´t bad enough, gossip, secrets, and fallouts from former relationships are being broadcast online for all to see. In addition, several high-profile teen suicides have highlighted the importance of educating children about how to protect themselves from cyberbullying and the vicissitudes of the social networking world.

An article in The New York Times identified some of the challenges surrounding cyberbullying, including the roles and responsibilities of children, parents, the schools, and the legal system. The article raises more questions than it provides answers. It makes it clear, however, that children need to be educated about how to prevent cyberbullying, what to do if they are being bullied, and how to use digital media responsibly. Here are some ideas for you and your child to prevent or manage cyberbullying:

Talk to your children about cyberbullying as they are getting a cell phone or a social networking account. Explain the warning signs of cyberbullying for themselves and towards others. They should have had a firm lesson in the golden rule and how they should be treated and treat others.

• Discuss with your children how to protect themselves from cyberbullying. They should only “friend” actual friends and not just acquaintances on social networking sites. They should not post or send via cell phone anything that they would not want everyone to see. ´Sexting´or the sending of nude photos is strictly prohibited and talk to them about the possible consequences of this type of behavior. Let them know that any photos posted on the Internet, stay on the Internet.

• Monitor your child´s behavior on cell phones and online through frequent conversations. If you think that they may be in danger, you may need to increase the amount of monitoring by getting account passwords or using random cell phone checks.

• Discuss who they can talk to if they are being bullied – parents, a trusted teacher, counselor, or a responsible friend. Adolescents are often wary of talking to parents about this for fear of overreaction, so give them other good options.

• If bullying continues to be a problem, problem-solve with your child. Consider talking to the bullies' parents, school administrators, or if severe enough, to the legal system or law enforcement. Consider changing cell phone numbers or closing accounts.

• If your child is doing the bullying or using the cell phone or social networking account inappropriately after re-direction, consider taking away the cell phone or closing social networking accounts. While there are many positives to this type of technology, remember that it is a privilege and not a right.

For more information, check out the National Crime Prevention Council and Read more about bullying on 

Thursday, July 1, 2010

“What do I tell my kids?” Tips for talking to children about the Gulf Oil Spill

By Molly McVoy, M.D.

I did a quick Google search of kids and the Gulf oil spilland I found everything from “Why are they killing all the birds and sea turtles?” to resources for environmentally minded children on how to start an environmental action plan of their own.

The oil spill in the gulf coast has many worried, from children through adults. The resources for how to talk to them are varied and sometimes confusing. Below are some basic tips for talking to children about the oil spill threatening the gulf coast.

Talking to your children about disasters can be challenging. Children ask tough questions and it can be difficult to know how best to answer them. However, times like this, during disasters, can be a golden opportunity with your children. When current events are scary or confusing, it can be a great opportunity for parents to show their children that there are people to help them and the country get through them.

The best advice I can give for talking to children about anything, but disasters in particular, is this - be honest, be simple and repeat, repeat, repeat. Don’t force your child to talk about the oil spill, but, if they ask, tell them the truth in language that fits with their age. Children know if they’re being told the truth, so answer them as simply and straightforwardly as you can. But, being a child, they will likely ask again and again (and again!). It’s okay if you have to repeat yourself, it’s the open dialogue and the reassurance that children are looking for during times of crisis.

So, as Bill Cosby said of fatherhood “You just need a lot of love and luck - and, of course, courage.”